Predictable and preventable

"I remember," says Dina Said, a secondary school student. "Abdel-Rahman, our young neighbour, was playing on the street. One minute he was running around, the next lying motionless on the asphalt. A speeding car had passed. I thought it would stop in time, it just didn't."

Abdel-Rahman was one of 8,000 casualties of the road in Egypt last year; a further 29,000 were injured in a total of 30,000 accidents. Judging by tragic media images of Atfih village schoolgirls soaked in blood last month, this year has been no better. It is a misfortune Egypt shares with the entire world, where road accidents claim upwards of 1.2 million lives annually, 90 per cent of which are in developing countries.

The reasons are the same the world over; speed, careless driving, bad roads. In Egypt, however, it is the phenomenal violation of traffic laws -- failure to observe conventions of lane change or right of passage, to use headlights at night, to refrain from backing up or overtaking at will -- that lies behind the problem in many cases. This has been taken into account in the latest WHO initiative, the United Nation Global Road Safety Week, in which WHO's East Mediterranean Regional Office (EMRO) and the National Council for Road Safety (NCRS) -- established in 2001 and working since 2003 -- are among many local partners; the Auto Club, the ministries of interior, health and population, transportation, road construction and education, and the American Embassy, not to mention NGOs and private-sector parties. All are involved in the formulation of a holistic plan to counter road accidents in Egypt.

According to Hisham Fouad, the official representative of the General Authority on Roads and Bridges at the NCRS, "recurrence finally made people realise it will take effort and thinking to reduce road accidents. We've taken the opportunity of this week to intensify our efforts and adopt new approaches; it's an excellent platform for implementing the three Es of traffic safety: engineering, education and enforcement. Our plans, in the Department of Engineering, which covers five to seven per cent of the problem, with nine to 15 per cent caused by faulty vehicles and 75 per cent due to the human factor: to undertake reconstruction of the Cairo-Alexandria desert road and the Rafah-Salloum highway; underpasses to replace U-turns, and rails to prevent road crossing for a start."

Hussein Allam, a financial advisor, feels that the quality of the roads is of the essence. Once, on moving into the curb to avoid a collision, he ran into a traffic police station positioned a few inches into it; it has since been removed. Another time, loose pebbles from a truckload broke his windshield on the road. He complains of poor paving and an unlit stretch of the Qattameya highway where pedestrians have often jumped over the low railing to their death. In Egypt, road signs are "a strange notion", he says: rather than giving clear directions or even reminding you to drive safely, they often communicate the most irrelevant and distracting information: the 99 names of God, for example, or else wise sayings. Shady Ibrahim, a sales manager, agrees that major roads like the 6 July Corridor, which he takes every day to get to his home in 6 October City, are in poor condition; his main gripe, however, is with car maintenance which, as he puts it, is "not an Egyptian notion". There is not enough road space in the country to accommodate the number of cars being used, he insists, admitting that he tends to speed: "the traffic keeps people motionless in their cars for a minimum of three hours daily. It's only natural that, their patience tried in this way, once they have a chance to, they will speed. If there were decent public transport of any kind, people wouldn't end up buying so many cars."

To get to town from 6 October and vice versa, for example, there are not enough buses, no metro, no viable way of commuting except by private car. Microbuses, the only alternative, are behind most road accidents in Egypt; Ibrahim's own theory is that, though they are officially banned from using it at all, the 15 May Bridge, which connects with the Corridor, actually provides microbuses with the majority of their stations: "In the absence of any affordable alternative, however, it would be impossible to get them all off the road." Nor, sadly, does the story end at road hazards per se.

Once you have had an accident, indeed, medical help might not prove to be very efficient. This is surprising in the light of the testimonies of the people in charge. While the Ministry of Health and Population is developing an injury surveillance system with EMRO support, Sherif Abdel-Fattah, deputy general manager of the Dar Al-Fouad Hospital, says there are 50 emergency- ready ambulances placed at 50km intervals on highways, a number that increases to 120 during the summer when, along the road to the north coast resort of Marina, for example, the number of accidents increases dramatically. "It's true," says Abdel-Fattah, "that highway medical services are being upgraded even as we speak. The problem is rather the lack of the kind of monitoring necessary to reduce accident rates." He points to various phenomena that make this particularly obvious: speeding trucks with unleashed metal shipments; U-turns in place of exits; no alcohol and drug tests for drivers. Such procedures, enforced internationally, would not only reduce accidents but increase survival rates as well: "Often, you see, the accident is so horrible that by the time the ambulance arrives there is nothing to be done."

The problem is not restricted to highways. Secondary school students like Alaa Abdel-Rahman and Marwa El-Fiqi, whose Abdel-Aziz Abaza Girls School in Heliopolis is located on a main road, remember many an occasion when they were almost killed; the pavement being too high, with the benefit of neither crossing points, a pedestrian bridge nor even traffic lights anywhere near the school entrance. Munira Ibrahim, a teacher, points out that without speed bumps or signs, the probability of a student being in a car accident is high. For his part Fouad feels that local roads are "the responsibility of the governorate," though, indicating the need for collaboration.

Faulty driving, and laxity in enforcing traffic regulations also play their role in making driving an often lethal exercise. Drivers often violate traffic laws, make unsafe lane changes and fail to yield the right of way to other vehicles or pedestrians. Motorists may also back up with their cars on main over-passes should they miss an exit, or else, speed and fail to use their headlights at night. Such transgressions have been enumerated in the brief assessment made by the Association For Safe International Road Travel (ASIRT). The latter is an NGO founded by Rochelle Sobel, an American mother who lost her son in a bus crash in Turkey 12 years ago. Since then, Sobel has become an activist in road safety matters. She has established road travel country reports, promoted road safety guidelines and joined efforts with WHO in establishing their publication entitled Faces Behind Figures, which comprises mini- biographies of casualties worldwide. "The possibility of being killed on the road in Egypt is 44 times higher than it is in the United States. One must bear in mind here that the US is still a high- risk country, when it comes to road safety," Sobel noted, emphasising the immense need to alter and improve road culture. "Driving is a public not a private activity," she said.

Abla El-Badry, head of the service committee at Nasr City Rotary Club, couldn't agree more. One of the club's main projects is targeting safety on the street, in collaboration with the Young Roteract Club. The project's main components comprise raising the new generation's awareness of the basics of road safety, putting black boxes in the buses of two schools and two travel agencies; and engaging in advocacy.

"We've approached government officials, and our efforts were fruitful, with the ministers of transportation and interior issuing a decree that now obliges travel agencies to add the black box to all their buses." Al-Badry aspires to achieve even more. "The next step is to enforce the usage of black boxes in microbuses and school buses nationwide. This would enhance the authorities' ability to monitor and punish those who break traffic laws."

According to the WHO-EMRO world report on road traffic injury prevention:

Deaths:

ï In 2002 there were an estimated 132,207 road traffic deaths in the Eastern Mediterranean, equivalent to 362 per day and 2,535 per week.

ï 99 per cent of deaths were in low- and middle-income countries.

ï 73 per cent of the casualties were male, 27 per cent female.

Rates and ranking of road traffic as a cause of death and injury:

ï 26.3 deaths from road traffic injuries per 100,000 in the Eastern Mediterranean.

ï Road traffic ranked sixth in 2002 as the cause of death in the Eastern Mediterranean (sixth for males, 11th for females).

ï Road traffic injury ranked sixth as a burden of disease (measured by DALYS) in the Eastern Mediterranean (fifth for males, eighth for females).

High- and low-income countries:

For low- and middle-income countries road traffic injury ranked seventh as a cause of death, whereas for high-income countries it was fourth. For low- and middle- income countries the ranking of road traffic injuries by DALYS was sixth, whereas in high-income countries it came third.

Past and projected growth in road traffic deaths:

World Bank analyses and projections for the period 1990-2020 show that road traffic deaths have increased substantially. The increase in road fatalities for the period 1990 to 2000 for the Middle East and North Africa is over one third. The projection for 2020 estimates a further 68 per cent increase with a rise in rates from 19.2 to 22.3 deaths per 100,000.

Cost:

Available data shows that the average annual cost of road crashes is about one per cent of the gross national product (GNP) in developing countries, 1.5 per cent in countries in transition and two per cent in highly-motorised countries. The total annual average cost of road crashes in low- and middle-income countries was estimated at $65 billion, which exceeds the total annual development assistance.

Annual road crash costs in 1997 were estimated at 1.5 per cent of GNP, the equivalent of $7.4 billion in the Middle East.

Facts about road safety, WHO

ï More than 1.2 million people die in road traffic crashes every year.

ï As many as 50 million people are injured or disabled by road traffic crashes every year.

ï Road traffic crashes cost countries up to four per cent of their GNP.

ï Correctly used seat-belts reduce the risk of death in a crash by 61 per cent.

ï Mandatory use of child restraints can reduce child deaths by 35 per cent.

ï Helmets reduce fatal and serious head injuries by up to 45 per cent.

ï Enforcing a drinking and driving law around the world could reduce alcohol-related crashes by 20 per cent.

ï For every 1km/h reduction in average speed, there is a two per cent reduction in the number of crashes.

ï Simple low-cost engineering measures could save thousands of lives.

ï As a car speeds up from 50km per hour to 80km per hour, it is eight times more likely to be involved in killing a pedestrian.